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General NPI Number Information
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NPI Number | 1619162401
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Entity Type | Organization
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Legal Business Name | FULLER EYE CARE ASSOCIATES, O.D., P.A.
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 09/13/2007
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Provider Practice Location Address
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Address Line | 2B HAW CREEK LN
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City | ASHEVILLE
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State | NC
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Zip | 28805-2250
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Country | US
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Telephone | 828-298-0854
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Fax | 828-298-2738
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Provider Business Mailing Address
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Address Line | 2B HAW CREEK LN
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City | ASHEVILLE
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State | NC
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Zip | 28805-2250
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Country | US
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Telephone | 828-298-0854
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Fax | 828-298-2738
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS SCOTT FULLER
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Credential | O.D.
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Telephone | 828-298-0854
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1477
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License Number State | NC
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